Iranian Red Crescent Medical Journal
Volume:13 Issue: 4, Apr 2011

Because economic data on the prophylactic usage of antibiotic in Iran are scant, we have conducted a cross-sectional study with provider perspective to measure costs and appropriate use of antibiotics in surgical wards of 6 training hospitals affiliated to Shiraz University of Medical Sciences (SUMS), Iran. Over a six-month period 1,000 consecutive patients undergoing surgical operation were enrolled and information on prophylactic antibiotic administration was collected. The information included basic patient's demographic data, types of surgery, category of antibiotic, dosage, dosage intervals, route of administration, number of doses, initiation times and duration of administration. In order to determine the agreement between prescribed antibiotics and medical indication, the American Society of Health-System Pharmacists (ASHP) guidelines were applied. Nine hundred and ninety three out of 1,000 patients (99.3%) had received at least one antibiotic and 908 patients (91.4 %) received antibiotics because of a medical indication. Five out of 913 patients who had indications for antibiotic prophylaxis did not receive any antibiotic. Antibiotics were prescribed for 85 out of 87 (98%) procedures in which an antibiotic was not indicated. The average cost of antibiotic prescription per surgical procedure was 786,936 Iranian Rials (corresponding to 99.60 USD or €82.90). The most frequent prescribed antibiotic was cefazoline adding 53.3% of the total cost of antibiotics. In total, 36,516,190 Iranian Rials (corresponding to 4,622.95 USD or €3,845.20) were spent for cefazoline alone. The results of this study showed that all surgical patients received at least one antibiotic as prophylaxis for any infection in the surgical site. Our results indicate over- and misuse of antibiotics in Iran leading to a great amount of economic burden, since in 98% of all procedures, antibiotics were used inappropriately.

The optimal antibiotic regimen is still controversial in open fractures. The purpose of this study was to evaluate the efficacy of two different antibiotic regimens in management of type III-A open fractures. From January 2001 to January 2008, patients with type IIIA open fractures admitted in Shahid Beheshti Hospital Affiliated to Babol University of Medical Sciences were enrolled. Patients randomly received cefazolin plus gentamicin (group I) or cefazolin plus ciprofloxacin (group II). Both regimens were administered for 3 days. All patients were followed for 3 months. The efficacy of both regimens was compared. One hundred-forty eight and 153 patients were treated in group I and II, respectively. The mean age of the patients treated in group I was 36.96±14.4 and in group II was 36.93±13.51 years. The rate of deep infection in group I was 5.4% and in group II was 6.5%. The efficacy of regimen I was 94.6% and regimen II was 93.5%. Cefazolin plus gentamicin, or cefazolin plus ciprofloxacin both can be successfully used for prevention of infection in type IIIA open fractures.

TNF-α as a pro-inflammatory cytokine play a key role in host defense against tuberculosis (TB). Presence of mutation in TNF-α gene can influence the effectiveness, performance and capability of immune responses against this infection. The Aim of this study was to investigate the frequency of TNF-α alleles and its relationship with susceptibility to TB and TNF-α gene variations. A case-control study was conducted and 103 healthy controls and 93 TB patients were enrolled. Genotype of TNF-238, TNF -244, TNF-308, TNF -857 and TNF-863 were distinguished using PCR-RFLP method. TNF-857 and TNF-863 were in high frequency mutation regions in a population level, and a significant difference at TNF-857 was noticed between the two groups of case and control. Presence of mutation in TNF-857 region probably increases the host susceptibility to mycobacterial infection. Genotyping of these regions in combination with other factors can be used for screening of high risk persons. According to high distribution of mutations in TNF-857 and TNF-863 regions, further studies on association of these regions is suggested.

Zinc is an essential micronutrient for human health. However, little is known about concentration of this mineral among Iranian population. This study was carried out to determine the current zinc status, evaluate the impact of certain factors like age, sex and Body Mass Index (BMI), and to verify the prevalence of zinc deficiency among Iranian adult population in Shiraz, southern Iran. Serum samples from 374 randomly selected healthy individuals living in Shiraz, Iran, aged 19-82 years (143 males, 231 females) were collected and the serum zinc concentration was measured by Flame-Atomic Absorption Spectrometry. We considered the subjects with serum zinc concentration less than 100 µg/dl as zinc deficient. The serum zinc levels in females were lower than those of males with no statistically significant difference. Serum zinc concentrations were unrelated to age and BMI. It also did not change among different ages and BMI intervals. About 42.5% of our cases had serum zinc concentration below the cut off value of 100 µg/dl in the serum. Designing appropriate strategies for overcoming this public health problem is necessary.

Apolipoprotein E (APOE), which its ε4 allele has been reported as a risk factor in late onset Alzheimer’s disease (AD), is the main cholesterol carrier in the brain. ATP-binding cassette transporter A1 (ABCA1) gene on chromosome 9, which has been known by genome-wide AD linkage study, has an important role in cellular cholesterol efflux. This study determines the association between sporadic AD and the human ABCA1 and APOE gene polymorphisms in Iranian population. 154 AD cases and 162 control subjects from Iranian population were genotyped for APOE genotypes and ABCA1 polymorphism (R219K). The frequency of ε2ε3 genotype was higher in control subjects comparing AD patients but was not significant (13% versus 5.8%) and ε3ε4 genotype frequency was significantly higher in AD cases comparing with control subjects. APOE-ε2 allele frequency in cases was lower than control subjects but this difference was not significant (4.5% versus 8%). Individuals carrying ε4 allele, developed AD 6.5 times more than non-carriers (OR=6.52, 95%CI=2.63-16.17). There was no significant association between ABCA1 polymorphism and AD. Unlike other studies, R219K polymorphism was not dependent on gender and APOE-ε4 allele and there was no association between APOE and ABCA1 in AD patients compared to controls.

Based on beneficial reports of pamidronate use for reflex sympathetic dystrophy in reduction of pain and swelling, this drug can be studied as a novel treatment for refractory lymphedema. This study aims to determine the effectiveness of pamidronate on lymphedema and its possible side effects. Twelve cases of lower limb refractory lymphedema were enrolled. They received intravenous pamidronate monthly for 3 consecutive months and were followed by measuring any discomfort with visual analog scale (VAS) and physician global assessment, based on objective signs of limb volume and circumference. The limb volume, circumference, and satisfaction of the patients improved significantly. Pamidronate when is added to conservative treatments may reduce lymphedema and improve the patient’s comfort.

Today, hospitals and patients are both willing to benefit from outpatient services. Considering limits of supply, it seems that there is a need to run productive management in offering health services to prevent wasting of supplies and facilities. This study compares the complications caused by hemorrhoidectomy in outpatient and inpatient operations. In a cross-sectional study during 1.5 years, 208 patients without any background disease were enrolled. They were randomly allocated into two groups (inpatient and outpatient) and interviewed within two weeks after surgical operations. The data were collected through a questionnaire and physical examination. The complications in the two groups of operating theater of hospital and clinic were then compared regarding sex, occupation, education and etc. One week after the surgical operation, the patients in the hospital operating theater showed significantly a better healing recovery of their wound. Other complications such as pain, hemorrhage, infection, inflammation, involuntary emission of feces and gas indicated no significant difference between the two groups. After 2 weeks, more pain was noticed in patients in the operating theaters of the hospital and in clinics, there was more infection visible. The hemorrhage, inflammation, wound healing, involuntary emission of feces and gas did not indicate a significant difference between the operating theater of hospital and the clinic. There was no significant difference regarding the patient's satisfaction in the two groups. We recommend that for optimized use of supplies and equipments in operating theaters and to lower the cost and shorten queue of patients, grade 2 hemorrhoids are performed in the operating theater of clinics considering sterilization and safety procedures.

The therapeutic effect of herbal materials in inhibition of cancer cell growth was shown. This study investigates the effect of fig tree latex (Ficus carica) on stomach cancer line. The in vitro effect of different doses of fig tree latex on stomach cancer cell line and the peripheral blood mononuclear cells was evaluated after 72 hours. Fig tree latex could inhibit the proliferation of cancer cell line without any cytotoxic effect on human normal cells. Five mg/ml was the optimum concentration in inhibition of cell line growth. Cancer cell line was more sensitive to Ficus carica latex than normal cells. This anticancer activity might be due to presence of its proteolytic enzymes.

Spontaneous aortocaval fistula is a rare complication of abdominal aortic aneurysms. We describe two cases of spontaneous aortocaval fistula. The first patient is a woman who was admitted with abdominal pain and pulsatile abdominal mass. Another patient was a man admitted with progressive abdominal pain and hypotension. Computed tomography (CT) scan in both patients showed an infrarenal aortic aneurysm and simultaneous contrast enhancement in the inferior vena cava. Both patients underwent an urgent laparotomy in which the diagnosis of an aortocaval fistula was confirmed. We review the literature on spontaneous aortocaval fistula as a consequence of complicated aortic aneurysms.

Lipoid proteinosis is a rare autosomal recessive disorder which may be seen within a family very occasionally. Herein, we report lipoid proteinosis in two sisters characterized by verrucous lesions and hoarseness of voice, dysphagia and multiple beaded papules along the margins of their eyelids, fissured lips and thick ferenulum.